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Clinical Crossroads
March 24/31, 1999

An 87-Year-Old Woman Taking a Benzodiazepine

Author Affiliations

Author Affiliation: Dr Salzman is Professor of Psychiatry, Harvard Medical School, and Director of Education and Director of Psychopharmacology, Massachusetts Mental Health Center, Boston, Mass.

 

Clinical Crossroads at Beth Israel Deaconess Medical Center is produced and edited by Thomas L. Delbanco, MD, Jennifer Daley, MD, and Richard A. Parker, MD; Erin E. Hartman, MS, is managing editor. Clinical Crossroads section editor: Margaret A. Winker, MD, Deputy Editor, JAMA.

JAMA. 1999;281(12):1121-1125. doi:10.1001/jama.281.12.1121

DR PARKER: Ms B is an 87-year-old woman who has taken benzodiazepines for at least 15 years. Her physician is trying to weigh the risks and benefits of continuing her therapy with alprazolam or attempting to taper it off. Ms B lives alone and independently near Boston, Mass, and has her health insurance through Medicare.

Ms B describes anxiety symptoms occurring since at least young adulthood. She speaks of "worry about illness in family members," generalized uncomfortable anxiety, "low mood" without clear depressive symptoms, and a "hard life" with few breaks. Her affect is flat, her mood sad, and her thoughts pessimistic. "I've never had joy in my life—just tried to get through day by day." She has always been single. She attributed her inability to succeed in relationships with men to her hysterectomy, which made her unable to bear children. She derives pleasure from playing the piano, but she has little motivation to seek interpersonal contact or pleasurable activities. She has never presented with a frank clinical depression.

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